Sexual Problems in Women

Topic Overview

What are sexual problems?

A sexual problem is something that keeps sex from being satisfying or positive.

Most women have symptoms of a sexual problem at one time or another.
For some women, the symptoms are ongoing. But your symptoms are only a sexual
problem if they bother you or cause problems in your relationship.

There is no "normal" level of
sexual response because it's different for every
woman. You may also find that what is normal at one stage of your life changes
at another stage. For example, it's common for an exhausted mother of a
baby to have little interest in sex. And it's common for both women and men to
have lower sex drives as they age.

What are some causes of sexual problems in women?

Female sexuality is complicated. At its core is a need for closeness and
intimacy. Women also have physical needs. When there is a problem in either the
emotional or physical part of your life, you can have sexual problems.

Some common causes include:

Emotional causes, such as
stress, relationship problems, depression or anxiety,
a memory of sexual abuse or rape, and unhappiness with your body.

Physical causes, such as hormone problems, pain from an injury or
other problem, and certain conditions such as
diabetes or
arthritis.

What are the symptoms?

How are sexual problems in women diagnosed?

You may notice a change in desire or sexual
satisfaction. When this happens, it helps to look at what is and isn't working
in your body and in your life. For example:

Are you ill, or do you take a medicine that
can lower your sexual desire or response?

Are you stressed or
often very tired?

Do you have a caring, respectful connection with
a partner?

Do you and your partner have the time and privacy to
relax together?

Do you have painful memories about sex or
intimacy?

Your doctor can help you decide what to do. He or she
will ask questions, do a physical exam, and talk to you about possible causes.

It can be hard or embarrassing to talk to your doctor about this. Sometimes it helps to write out what you want to say
before you go. For example, you could say something like, "For the past few months,
I haven't enjoyed sex as much as I used to." Or you could say, "Ever since I
started taking that medicine, I haven't felt like having sex."

How are they treated?

Treatment for a sexual problem depends on the cause. It may include treating a health
problem, learning how to talk openly with your partner, and learning about things you can
do at home. For example, you might take a warm bath to relax, have plenty
of foreplay before sex, or try different positions during sex.

It's important to feel comfortable talking with your doctor. The more you can tell your doctor, the more he or she will be able to help you.

Cause

Your sexuality is a mixture of mental,
emotional, and physical signals. A problem in one area can grow to involve
other areas.

Mental and emotional causes: These include stress, depression, relationship problems, fear, a history of sexual abuse or rape, and being unhappy about your body.

Physical causes: These include natural hormonal changes, such as those related to your
menstrual cycle, birth control pills, or pregnancy. Physical causes also include injuries, pain during sex, and certain health problems, such as diabetes, endometriosis, or arthritis.

Medical treatments: Sometimes treatments for other illnesses or conditions—such as past surgeries or cancer treatments—cause changes that result in pain during sex or other problems. For example, it's common for a woman who has had her
breast removed or has had her uterus and
ovaries removed to have less sexual desire.

Medicines: Some medicines may lower sexual desire and arousal. These include certain medicines for high blood pressure, diabetes, depression, and allergies.

Getting older: As a woman ages, she may have a decrease in sexual desire. She may need more time to feel sexually aroused. And aging can cause physical changes. Vaginal walls may grow thinner. The vagina itself may narrow or shorten. There may be less lubrication. These changes can cause pain during sex.

Alcohol and drug abuse: Drinking too much or continually using illegal drugs like cocaine or amphetamines will eventually cause problems with orgasm and sexual desire.

Symptoms

Symptoms of
sexual problems can include:

Less desire. You may have fewer sexual fantasies or thoughts. You may not want to have sex.

Less arousal. You may notice that you're not interested when a partner makes sexual suggestions. You may not be able to feel
or maintain sexual excitement.

These symptoms are problems only if they bother you or cause problems in your relationship with a
partner.

What Happens

Many things in a woman's life can lead to a sexual problem. Over time, an untreated sexual problem can have a growing impact on your quality of life. If the problem makes you feel uncomfortable and/or unsatisfied, sex can become a tense and unwelcome experience.

Physical influences

Women normally experience a physical change
during sexual arousal, as blood swells areas of the
vulva. If those areas aren't stimulated enough, a woman may not feel as much sexual pleasure.

Chronic (ongoing) illnesses, such as
diabetes and
arthritis, can affect sexual desire, enjoyment, and
performance.
Medicines for many medical conditions also affect
desire and arousal.

Pain during sex

Any history of pain during sex may cause a
woman to avoid sex or find it unpleasant.

Pain during sex may result from:

Vaginal dryness. Lack of lubrication in the vagina is the most common cause of pain with sex.

Vaginismus (say "vadj-uh-NIZ-mus"). This is an involuntary contraction of the vagina. It's often related to a lack of experience with sex.1 Sometimes it stems from a trauma such as rape or sexual abuse. But there can also be a medical cause, such as:

Dyspareunia (say "dis-puh-ROO-nee-uh"). This is physical pain that occurs during entry into the vagina, during deep thrusting, or after sexual intercourse.

Partner and emotional influences

Living situations that give
couples very little privacy can interfere with feelings of
arousal.

Your partner's level of sexual skill and attention
can play a big part in your sexual enjoyment. A positive,
respectful connection between partners sets the stage for sexual interest and
arousal.

Positive sexual experiences help build a healthy
sexuality. On the other hand, a woman who has had a forced sexual experience is
likely to have mixed feelings about sex. In one study, 1 out of 5 women reported
having been forced to do something sexual. This was most often done by someone
they were close to.2

Some women feel guilty, embarrassed, ashamed, or self-conscious during sex.

A woman may avoid sex because she's afraid that an illness (such as cancer) or surgery (such as mastectomy or hysterectomy) will make sexual activity unpleasant for one or both partners.

Age-related influences

As a woman ages, she may have sex less often because she no longer has a partner or her partner has lost interest in or is no longer able to have sex. Many older women also report problems with lubrication.

Women may notice less desire for sex after menopause.

It may take longer to feel
sexually aroused, and
orgasms may be briefer. But orgasms still will offer
mental and physical pleasure to most women.

Women can feel sexual pleasure throughout their lives. But those
who stop having sex after menopause have more shrinking and drying of the
vagina than women who continue to have sex.2

What Increases Your Risk

A risk factor is anything that increases your chances of having a problem. The main risk factors for sexual problems are:

Having poor mental and emotional health.

Having problems with your sexual relationship.

Having a partner who has problems with sexual function.

Other risk factors include:

Exhaustion, often from round-the-clock care of
a baby or small children and/or parenting and having a job.

Testosterone. Testosterone is sometimes
used after natural or surgical menopause to improve sex drive. But long-term use of testosterone has not been shown to be effective in increasing sexual desire.3

Getting
counseling as a couple can help strengthen your emotional connection with your
partner. Improving a stressed relationship is likely to improve your sexual
relationship.

There are also steps you can take at home that may raise your sexual desire. To learn more, see Home Treatment.

Having a partner you feel comfortable and
nonstressed with plays a big part in your desire level. It's normal to lack desire for a partner who forces
sex or is verbally abusive or physically violent.

Treatment for decreased sexual arousal

Treatment for decreased sexual excitement may
include learning about the role emotions play and about how a woman's arousal sometimes depends on stimulating other parts of her body, especially her breasts.

Treatment may also include:

Changing treatment for certain illnesses, if that treatment has side effects that lower your arousal.

Counseling, to help adjust expectations of sexual
activity. If too much pressure is put on partners to perform, it can affect arousal.

Steps you can take at home, such as use of vaginal lubricants or masturbation.

Treatment for inability to reach orgasm

Treatment usually begins with
changing any medicine that is known to affect orgasm. But don't stop taking your medicine without talking to your doctor first.

If you're having trouble with orgasm or it takes much longer than it used to, you can try a number of things at home, such as self-stimulation and fantasy.

It may also help to find out more about sexual response. For example, most women find it easier to have an orgasm from direct clitoral stimulation. And most couples do not have orgasms at the same time.

Treatment for pain

If pain is caused by a physical problem, treating that problem may get rid of the pain. But pain during intercourse may have
more than one cause, including psychological causes such as anxiety or the
memory of sexual assault.2

Pain when penis enters the vagina

Pain that occurs when the penis first enters the vagina may be caused by involuntary contractions of the vagina
(vaginismus). This is sometimes related to a lack of experience with sex.1

Treatment may include a program of
progressive muscle relaxation and gradual vaginal dilation, possibly including
psychotherapy.

But pain during initial penetration also may be caused by
vaginal irritation or another physical problem. If so, getting rid of the pain
will require treating the physical reason.

Other pain during intercourse

If the pain is caused by the deep thrusting of the
penis, the cause may be a pelvic disease. But it may also be caused by not being able to relax. Being able to talk openly with your doctor will help you explore the cause of the pain and decide on treatment.

Treatment for aging and menopause-related sexual problems

Vaginal dryness after menopause can sometimes be treated at home with lubrication.

If
home treatment doesn't work as well as you need it to, talk to your doctor about
using estrogen. This hormone can be used in several forms to help menopause-related problems. To learn more, see Medications.

Become familiar with your
own patterns and methods of sexual arousal, perhaps through
masturbation.

Understand that many women do not always have
orgasms during sex and that mutual pleasure can be a
satisfying way to have sexual intimacy.

Use plenty of lubrication for
your vagina to avoid dryness. This is the most common cause of painful
sex.

Enjoy tenderness and closeness. And avoid expectations
of great sexual performance.

Being sexually active with a partner or through masturbation helps maintain vaginal health. And having regular sexual intercourse helps preserve vaginal elasticity and keeps vaginal tissues from shrinking.

Home Treatment

You can try a number of things at home that may help your sexual problems.

Working with your partner

Increase the level of intimacy and foreplay with your partner before penetration.

Experiment with different sex positions to find the most comfortable ones.

Think about changing your setting and routine to improve
your time together. Do you have enough privacy and time? Are you interested in
trying something new?

Try talking and listening to each other more.
This includes talking openly about sex, what each of you needs, and what you
want to do differently together.

Foreplay and relaxation

You may be able to increase your sexual desire and arousal with:

Masturbation, possibly with the
aid of a vibrator and/or with your partner.

Sensual massage and other pleasurable physical
activities without sexual intercourse.

Vaginal lubricants

Lack of lubrication in the vagina is the most common cause of pain with sex.

Nonprescription water-based products that
provide vaginal lubrication can help. You can typically find these
products, such as Astroglide and K-Y Jelly, at pharmacies, usually near the
condoms.

Vaginal moisturizers, such as Replens, are not for use right before sexual intercourse. But when used regularly, they can help with vaginal dryness.

Exercises for pelvic muscles

Exercises can help you develop muscular control of contraction and relaxation of the pelvic muscles.
This can increase sexual arousal and improve orgasm. You can improve pelvic floor muscle strength using
Kegel exercises or vaginal weights.

Vaginal weights usually come in five sizes. You start with the smallest weight, and work up to the largest over time. Insert a weight into your vagina, then hold it in place while standing upright for 15 minutes. Your muscles will feel the urge to tighten and hold it in.

After a few days, the vaginal muscles become strong enough that they no longer feel an urge to hold the weight. This is when you use the next larger weight. When you've used all five weights, keep your muscles toned by using the largest weight for 5 to 7 days in a row each month.

Medications

Medicines may be used in treating certain conditions that contribute to
sexual problems.

Lidocaine gel

For women who have pain in the area around the opening of the vagina (vulvodynia), putting on lidocaine gel shortly before sex may be helpful. Talk to your doctor about how to use the gel safely.

Estrogen for postmenopausal women

If you only have
vaginal dryness and irritation (and not other symptoms such as hot flashes),
you can use a limited amount of
estrogen in a cream, tablet, or ring in the vagina.
The daily estrogen makes your vaginal lining thicker.
Many women find that using a cream or tablet twice a week is enough. This may
increase vaginal tone and lubrication, which will decrease
vulvar dryness, irritation, and shrinkage (atrophy).

If you also have other
menopausal symptoms that affect physical and mental
well-being, talk to your doctor about taking daily estrogen.
Estrogen can increase the blood flow in the
vagina and reduce hot flashes and other
symptoms of
menopause.

Estrogen therapy or
estrogen-progestin therapy can be oral (pills),
vaginal, or transdermal (with a patch). In a small number of women, hormone
therapy can cause heart disease, breast cancer, ovarian cancer, dangerous blood
clots, stroke, and dementia. Talk to your doctor about whether this therapy is
right for you.

Testosterone

This hormone
may play a part in a woman's sex drive and satisfaction. Your ovaries make
testosterone throughout your life. Women have
the most testosterone in early adulthood. Testosterone levels drop by half
between the early 20s and the early 40s.

A woman who has had surgery to remove her uterus (hysterectomy) and ovaries (oophorectomy) will suddenly be in menopause. She will have an immediate drop in both estrogen and testosterone. She may then have a problem with sexual desire. If so, her doctor may suggest hormone therapy.

Other medicines

Sildenafil (Viagra), which is used to treat
erectile dysfunction in men, is being studied for use in women who have arousal problems but has not been shown to work.3

Surgery

Surgery isn't used to treat sexual problems unless pain is caused by endometriosis or another medical condition.

There are advertised procedures, such as "vaginal rejuvenation" surgeries, that promise to increase sexual pleasure. But such surgeries may not provide any benefit. And they may cause harm. They also may be costly and painful.

Other Treatment

Researchers continue to look for
treatments for raising sexual desire, arousal, and satisfaction. The research includes both devices and herbal supplements.

Some products,
such as different vitamins and herbs, are promoted as natural treatments for
sexual problems. But most of these products have not been subject to the same
kind of testing for safety and effectiveness that standard
medical treatments must go through before they are approved in the United
States.

If you decide to use an alternative medicine or supplement, follow
these precautions:

Talk with your doctor first, especially if you are pregnant or trying to
become pregnant, if you take prescription medicines, or if you have another health
problem.

Follow the directions on the label, and don't take more than the
recommended dose.

DHEA

Like testosterone, DHEA (dehydroepiandrosterone) is an
androgen made in the body. Over-the-counter
DHEA:4

Is
not known to improve sexual well-being in healthy women.

When taken by mouth, has the same risks of
liver damage and negative effects on your
cholesterol levels as
oral testosterone. It also has the same unwanted hair-growth and acne side
effects. This is because the body turns DHEA into testosterone.

Is not
regulated by the government, so you cannot know for sure how much you are
taking. Some DHEA supplements contain less DHEA than the labels claim. Others
contain more than the labels claim.

Eros Therapy Device

This is a small
battery-operated device used to stimulate engorgement of the clitoris. It was cleared by the U.S. Food and Drug Administration (FDA) for sale in the U.S. in 2000.

Using this device is said to increase lubrication and clitoral sensation, to help with achieving orgasm, and to improve women's sexual satisfaction.

Initial studies have shown good results in women reporting sexual problems and also in women recovering from cervical cancer treatment.4

Other Places To Get Help

Organizations

American Association of Sexuality Educators, Counselors,
and Therapists (AASECT)

1444 I Street NW, Suite 700

Washington, DC 20005

Phone:

(202) 449-1099

Fax:

(202) 216-9646

Email:

info@aasect.org

Web Address:

www.aasect.org

The American Association of Sexuality Educators,
Counselors, and Therapists (AASECT) is a nonprofit professional organization
that promotes understanding of human sexuality and healthy sexual behavior.
AASECT offers certification of sexual health practitioners. At their website, you can locate a therapist in your area. There is also a tab called "For the public" where you can link to FAQs on human sexuality, find member books and articles, and learn more about the profession.

American Congress of Obstetricians and Gynecologists
(ACOG)

409 12th Street SW

P.O. Box 70620

Washington, DC 20024-9998

Phone:

1-800-673-8444

Phone:

(202) 638-5577

Email:

resources@acog.org

Web Address:

www.acog.org

American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.

Association of Reproductive Health Professionals
(ARHP)

2401 Pennsylvania Avenue NW

Suite 350

Washington, DC 20037-1718

Phone:

(202) 466-3825

Fax:

(202) 466-3826

Web Address:

www.arhp.org

This organization of health professionals provides education and
information on reproductive health matters such as sexual health, sexually
transmitted diseases (STDs), family planning, contraception, and
infertility.

AUA Foundation: The Official Foundation of the American Urological
Association

1000 Corporate Boulevard

Linthicum, MD 21090

Phone:

1-800-828-7866

Phone:

(410) 689-3700

Fax:

(410) 689-3998

Email:

auafoundation@auafoundation.org

Web Address:

www.urologyhealth.org

UrologyHealth.org is a website written by urologists
for patients. Visitors can find specific topics by using the "search"
option.

The website provides information about adult and
pediatric urologic topics, including kidney, bladder, and prostate conditions.
You can find a urologist, sign up for a free quarterly newsletter, or click on
the Urology A–Z page to find materials about urologic problems.

National Institute on Aging

Building 31, Room 5C27

31 Center Drive, MSC 2292

Bethesda, MD 20892

Phone:

1-800-222-2225

Phone:

(301) 496-1752

TDD:

1-800-222-4225 (TTY)

Email:

niaic@nia.nih.gov

Web Address:

www.nia.nih.gov

The National Institute on Aging (NIA), one of the
centers of the U.S. National Institutes of Health, leads a broad scientific
effort to understand the nature of aging and to extend the healthy, active
years of life. The NIA funds research and provides information about health and
research advances to the public and interested groups.

North American Menopause Society (NAMS)

5900 Landerbrook Drive

Suite 390

Mayfield Heights, OH 44124

Phone:

(440) 442-7550

Fax:

(440) 442-2660

Email:

info@menopause.org

Web Address:

www.menopause.org

The North American Menopause Society (NAMS) is a nonprofit
organization that promotes the understanding of menopause and thereby improves
the health of women as they approach menopause and beyond. NAMS members include
experts from medicine, nursing, sociology, psychology, nutrition, anthropology,
epidemiology, pharmacy, and education. The NAMS website has information on
perimenopause, early menopause, menopause symptoms and long-term health effects
of estrogen loss, and a variety of therapies.

Office on Women's Health

Department of Health and Human Services

200 Independence Avenue, SW Room 712E

Washington, DC 20201

Phone:

1-800-994-9662(202) 690-7650

Fax:

(202) 205-2631

TDD:

1-888-220-5446

Web Address:

www.womenshealth.gov

The Office on Women's Health is a service of the U.S. Department of Health and Human Services. It provides women's health information to a variety of
audiences, including consumers, health professionals, and researchers.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.